title: Methods of haemostasis during liver resection--a UK national survey.
abstract: BACKGROUND
  Although haemorrhage is a major cause of morbidity and mortality in liver surgery, there is very little available guidance on its management.
  
  
  METHODS
  The aim of this study was to identify current practice in the UK in this regard. An online survey was created and hepatobiliary (HPB) specialists who were members of a specialist society and others who were known practitioners were invited by e-mail to complete the survey anonymously.
  
  
  RESULTS
  Fifty-one percent responded (n = 36/70), and most of these respondents worked at large HPB centres (>100 liver resections/year; n = 24, 66%). Not all questionnaires were fully completed by the individual surgeons. Thirty-eight percent of the surgeons routinely used Pringle's manoeuvre. Most surgeons used ligation of the inflow vessels (n = 16, 44%) and stapled the outflow vessels (n = 15, 42%). The Cavitron ultrasonic surgical aspirator (CUSA; 54%, 13/24) was preferred for parenchymal transection. The majority routinely used haemostatic adjuncts (n = 22, 62%), whilst 33% (n = 12) used them occasionally. Twenty-three (64%) felt manufactured haemostatic adjuncts played a major role in maintaining haemostasis and 19 preferred fibrin-based products.
  
  
  CONCLUSIONS
  The Pringle manoeuvre is a popular technique amongst specialist UK liver surgeons and the CUSA is used by nearly half of the surgeons. Despite the absence of definitive evidence for their benefit, manufactured haemostatic adjuncts are still widely used, especially the fibrin-based adjuncts.
authors.affiliation: Department of Hepato-Pancreato-Biliary and Transplantation Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: R
authors.initials: R
authors.lastname: Lochan
authors.forename: I
authors.initials: I
authors.lastname: Ansari
authors.forename: R
authors.initials: R
authors.lastname: Coates
authors.forename: S M
authors.initials: SM
authors.lastname: Robinson
authors.forename: S A
authors.initials: SA
authors.lastname: White
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D011159:Population Surveillance; D011795:Surveys and Questionnaires; D006113:United Kingdom